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This case study follows Casey, a child with significant speech and language deficits, from age 4 years 2 months until 9 years 9 months. It focuses on a 9-month period starting at age 5 years 9 months during which a meaning-based phonological intervention was used to improve his intelligibility and language skills. Clinicians evoked frequent word and sound productions in interactive, naturalistic contexts while manipulating levels of support for sound production and communicative complexity. Casey progressed from producing target words in routines with high levels of support to producing targets in scripted conversational exchanges with low levels of support. Although his phonological and language skills have improved, his academic, higher level language, and social concerns have become more apparent.